Is this a new trend?

[hppygr8ful]

A local hospital has been sending us residents with severe diaper dermatitis - I mean deep red excorriation so bad that the redisident in one case was bleeding. When I spoke to a family member I was told the nurses at the hospital did not use disposable briefs but instead put bath blankets of towels between the patient's legs and actually told the patients to go ahead and pee in their beds and they would clean them up after. But patients are sitting in their own waste.

When we called the hospital with the client/family complaint they denied the practice and said the parient had clear skin when they were discharged. There was a meeting with the CEO of the hospital today to discuss this problem.

I am just wondering if this a new practice I haven't heard of.

hppy

[Marshall1]

Not the hospital I work at - never would this be done.

[Red Kryptonite]

Another decision made by someone who hasn't touched a patient in a decade or two.....

[heron, ASN, RN]

Another situation in which one size does not fit all. I agree with no briefs in bed ... we use the old-fashioned quilted plastic lined bedpads and make incontinent rounds q2-3 hours. While up, the dignity issue gets more important and briefs or pull-ups are used. This is in LTC. Issues would be different in acute care, I would think.

Basically, one rule cannot reasonably apply to all possible situations. Anyone here remember the concept of individualization?

Some practices, like towels stuffed into briefs, are often just plain lazy. (One of the CNAs on my hospice unit used to stuff briefs with abd pads so the little yellow indicator stripe wouldn't turn blue.) But, when I think about the patient loads in acute care, with the lack of staff and the pretense of "primary nursing", I can understand how a nurse would consider such a measure out of sheer desperation.

[LadyFree28, BSN, LPN, RN]

This thread makes me enjoy having diapers-only because I work in Peds.

[NursesRmofun, ASN, RN]

This thread makes me enjoy having diapers-only because I work in Peds.

LOL

[NursesRmofun, ASN, RN]

True that each situation or facility might be different....However, when I think of what a CNA is capable of and other duties besides toileting or incontinent care, such as feeding and transporting, etc., in reality, in some places, a resident is not going to be changed or checked every 2 hrs. I think, in those cases, a brief is better than nothing...as some of the residents/patients are in w/c's. You would think that a resident/patient in a w/c would be changed quicker yet, but that is not always the case. Mealtime alone takes over an hr in the dining room...then the transport time and showers. I just can't see doing without briefs on some residents/patients that are heavily incontinent. If they aren't left on too long and moisture barrier cream may be used, the brief should actually help take the wetness off the skin.

[jrbl77, RN]

Speaking not as a nurse, but as the daughter of a elderly mom. The few times my mom was in the hospital and not allowed to wear her pull up style briefs, she felt lost. This was what she was use to wearing and her skin was in good shape. Now that she has dementia and can't get up by herself, she continues to wear briefs at the LTC. My mom pays for her own briefs, so cost is not an issue for her. I for one don't want to find my mom with wet pants and clothing when I come to visit. As a nurse, I understand the move to get away from briefs. The last place I worked, the staffing hardly allowed us to keep up with off and on the commodes or trips to the bathroom. We were not to use bedpans. A true problem that is only going to get worse as baby boomers age.

[mvm2]

Why not take diapers away from babies too since they must be as bad as briefs. Let them run around naked because briefs and diapers are apparently evil.

I really would like those that think just putting a chuck on a bed and let them eliminate is a good thing. These people should lay on their own beds at home and lay on a chuck and pee on their own beds and see how wonderful that is not to at least have a brief on that will help contain the pee from getting all over themselves.

[Red Kryptonite]

Why not take diapers away from babies too since they must be as bad as briefs. Let them run around naked because briefs and diapers are apparently evil.

I really would like those that think just putting a chuck on a bed and let them eliminate is a good thing. These people should lay on their own beds at home and lay on a chuck and pee on their own beds and see how wonderful that is not to at least have a brief on that will help contain the pee from getting all over themselves.

I'm with you. This whole discussion is like twilight zone to me.

[MunoRN, RN]

The reason they are discouraging briefs is because they cost more than toweling and Chux. A bean counter somewhere is probably charging the health care insurer for briefs but instructing staff to use towel. It all comes down to the mighty dollar.

Actually my facility's biggest concern was that it's far more expensive to not use briefs and just change linen more frequently. Each linen/pad change is a few bucks worth cleaning charges but a brief is less than one dollar each. So even if you're changing briefs as often as linen/pads it's cheaper to use briefs, then add the fact that the main purpose of briefs is to go longer between changes at it's clearly less expensive to use briefs.

[MunoRN, RN]

Why not take diapers away from babies too since they must be as bad as briefs. Let them run around naked because briefs and diapers are apparently evil.

I really would like those that think just putting a chuck on a bed and let them eliminate is a good thing. These people should lay on their own beds at home and lay on a chuck and pee on their own beds and see how wonderful that is not to at least have a brief on that will help contain the pee from getting all over themselves.

A brief by definition does not keep pee or stool from "getting all over themselves", it actually guarantees far more urine/stool skin contact than no brief.

[Julius Seizure]

Slight sidetrack here, but curious what you all have seen used as the best barriers to protect the skin whether briefs are used or not?

My favorites are:

Boudreaux's Butt Paste, or a DIY mix of Desitin + Nystatin + Maalox

And for extra protection, stoma powder, followed by no sting barrier spray, then topped off with either of the above creams.